Guide to Medical Billing Clearinghouses

07 Apr

In the healthcare reimbursement landscape, medical billing clearinghouses are rapidly becoming a larger and larger part of it. The function of a medical billing clearing house has to do with electronic healthcare claims processing and reimbursement. Clearinghouses are used by most independent billing companies and specialist in order to process their healthcare reimbursement claims.

In order to operate efficiently clearinghouses from generally depend on economies of scale. This means that by processing millions of claims each day or week, a clearing house is able to drive its average cost per claim down to a very low level. It would be very expensive for an independent billing organization to deploy the necessary resources to accomplish all of the detailed quality assurance activities that are required to meet minimum reimbursement standards. Most billing companies and practitioners see this to be an invaluable service. The reality is that if you are out of compliance in the healthcare reimbursement arena can lead to steep fines or even criminal penalties, particularly when dealing with a government reimbursement organization such as Medicare or Medicaid.  And because of this, most independent billing specialists choose to transfer a portion of the workload as well as a portion of the liability for their claims processing activities to large medical billing clearinghouses.This is a great idea if you select the right clearing house.

Aside from quality control functions, clearinghouses specialize in converting claims submitted by an independent billing company or specialist into a normal that is recognized by the various healthcare reimbursement organizations, government agencies, ad man other different insurance companies.

There is a setup fee charged by some surprise billing clearinghouses. The setup up fee is to add an independent billing specialist as a new client. They also normally charge a small fee for each claim that they process. Some clearing houses only charge for certain claims processing services. Most of the time, they will charge more for a Medicare claim, as the claim processing requirements are more stringent when government dollars are involved. Make sure you do your homework and consider all of your options if you get to a point where you feel you need the services of a medical billing clearing house.

You can get a lot more information on medical billing and coding in several online sites. With the information that you can get online about medical billing clearinghouses so that you will know better if you need the services of medical billing clearinghouse. Here is a related document at

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